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Cost-Effectiveness Analysis of First- and Second-Line Bevacizumab Plus Chemotherapy in Metastatic Colorectal Cancer

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Key Points

  • The incremental cost-effectiveness ratio for bevacizumab in the first-line setting was $571,240 per quality-adjusted life-year.
  • The incremental cost-effectiveness ratio for continuing bevacizumab beyond progression in the second-line setting was $364,083 per quality-adjusted life-year.

In a U.S.-based cost-effectiveness analysis reported in the Journal of Clinical Oncology, Goldstein et al found high costs per quality-adjusted life-year with the addition of bevacizumab (Avastin) to chemotherapy in first- and second-line treatment of metastatic colorectal cancer.

Study Details

In the study, two Markov models were used to assess the cost-effectiveness of fluorouracil (5-FU), leucovorin, and oxaliplatin (FOLFOX) with or without bevacizumab in first-line treatment and subsequent 5-FU, leucovorin, and irinotecan (FOLFIRI) with or without bevacizumab in second-line treatment.

Assumptions for survival benefits with first-line FOLFOX plus bevacizumab vs FOLFOX were derived from the N01966 trial, which showed a 1.4-month improvement in median overall survival with the addition of bevacizumab to FOLFOX or XELOX (oxaliplatin-capecitabine). Assumptions for survival benefits in second-line treatment were derived from the ML18147 trial, which showed a 1.4-month improvement in median overall survival when bevacizumab was continued beyond progression in combination with second-line 5-FU–based chemotherapy.

Quality-adjusted life-years were calculated by adjusting survival time for health-related quality of life using previously published mean utilities of 0.85 and 0.65 for first- and second-line settings. Costs were in 2013 U.S. dollars.

Cost-Effectiveness Estimates

Bevacizumab in first-line therapy provided an additional 0.10 quality-adjusted life-years (0.14 life-years) at a cost of $59,361, yielding an incremental cost-effectiveness ratio of $571,240 per quality-adjusted life-year. Continuing bevacizumab beyond progression provided an additional 0.11 quality-adjusted life-years (0.16 life-years) at a cost of $39,209, with an incremental cost-effectiveness ratio of $364,083 per quality-adjusted life-year. In univariate sensitivity analyses, the variables with the greatest influence on incremental cost-effectiveness ratio were bevacizumab cost, overall survival, and utility.

The investigators concluded: “Bevacizumab provides minimal incremental benefit at high incremental cost per [quality-adjusted life-year] in both the first- and second-line settings of metastatic colorectal cancer treatment.”

Daniel A. Goldstein, MD, of Winship Cancer Institute of Emory University, is the corresponding author for the Journal of Clinical Oncology article.

For full disclosures of the study authors, visit jco.ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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